|
CAD for Screening Mammography
|
Facility
OP
|
$82.00
|
|
| Hospital Charge Code |
1158804
|
| Min. Negotiated Rate |
$22.96 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.89
|
| Rate for Payer: Aetna Commercial |
$73.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Aetna Managed Medicare |
$22.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.46
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$75.44
|
| Rate for Payer: Health EOS Commercial |
$72.98
|
| Rate for Payer: HFN Commercial |
$75.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.50
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: NAPHCARE Commercial |
$49.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.44
|
| Rate for Payer: Quartz Beloit One Network |
$40.18
|
| Rate for Payer: Quartz Commercial |
$53.30
|
| Rate for Payer: Quartz Medicare Advantage |
$49.20
|
| Rate for Payer: The Alliance Commercial |
$328.00
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
Cadmium Level
|
Professional
|
$583.00
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
977891
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$553.85 |
| Rate for Payer: Aetna Commercial |
$553.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$501.38
|
| Rate for Payer: Aetna Managed Medicare |
$23.64
|
| Rate for Payer: Anthem Medicare Advantage |
$23.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.64
|
| Rate for Payer: Cash Price |
$174.90
|
| Rate for Payer: Cash Price |
$174.90
|
| Rate for Payer: Cigna Commercial |
$553.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$291.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.64
|
| Rate for Payer: Health EOS Commercial |
$530.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.64
|
| Rate for Payer: Multiplan Commercial |
$466.40
|
| Rate for Payer: Preferred Network Access Commercial |
$553.85
|
| Rate for Payer: Quartz Beloit One Network |
$256.52
|
| Rate for Payer: Quartz Commercial |
$332.31
|
| Rate for Payer: Quartz Medicare Advantage |
$23.64
|
| Rate for Payer: The Alliance Commercial |
$93.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.64
|
| Rate for Payer: WEA Trust Commercial |
$320.65
|
| Rate for Payer: WPS Commercial |
$104.02
|
|
|
Cadmium Level
|
Facility
IP
|
$583.00
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
977891
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$285.67 |
| Max. Negotiated Rate |
$536.36 |
| Rate for Payer: Aetna Commercial |
$524.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$308.99
|
| Rate for Payer: Cash Price |
$174.90
|
| Rate for Payer: Cigna Commercial |
$536.36
|
| Rate for Payer: Health EOS Commercial |
$518.87
|
| Rate for Payer: HFN Commercial |
$536.36
|
| Rate for Payer: Multiplan Commercial |
$466.40
|
| Rate for Payer: NAPHCARE Commercial |
$349.80
|
| Rate for Payer: Preferred Network Access Commercial |
$536.36
|
| Rate for Payer: Quartz Beloit One Network |
$285.67
|
| Rate for Payer: Quartz Commercial |
$349.80
|
| Rate for Payer: WEA Trust Commercial |
$320.65
|
| Rate for Payer: WPS Commercial |
$431.83
|
|
|
Cadmium Level
|
Facility
OP
|
$583.00
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
977891
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$2,332.00 |
| Rate for Payer: Aetna Commercial |
$524.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$501.38
|
| Rate for Payer: Aetna Managed Medicare |
$23.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$88.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.37
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.24
|
| Rate for Payer: Anthem Medicaid |
$24.43
|
| Rate for Payer: Anthem Medicare Advantage |
$23.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$308.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.64
|
| Rate for Payer: Cash Price |
$174.90
|
| Rate for Payer: Cash Price |
$174.90
|
| Rate for Payer: Cigna Commercial |
$536.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.43
|
| Rate for Payer: Dean Health Medicaid |
$24.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23.64
|
| Rate for Payer: Health EOS Commercial |
$518.87
|
| Rate for Payer: HFN Commercial |
$536.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$87.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.64
|
| Rate for Payer: Managed Health Services Medicaid |
$25.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23.64
|
| Rate for Payer: Multiplan Commercial |
$466.40
|
| Rate for Payer: NAPHCARE Commercial |
$35.46
|
| Rate for Payer: Preferred Network Access Commercial |
$536.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$24.43
|
| Rate for Payer: Quartz Beloit One Network |
$285.67
|
| Rate for Payer: Quartz Commercial |
$378.95
|
| Rate for Payer: Quartz Medicare Advantage |
$23.64
|
| Rate for Payer: The Alliance Commercial |
$2,332.00
|
| Rate for Payer: United Healthcare Medicaid |
$24.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.64
|
| Rate for Payer: United Healthcare PPO |
$437.25
|
| Rate for Payer: WEA Trust Commercial |
$320.65
|
| Rate for Payer: Wellcare Medicare |
$23.64
|
| Rate for Payer: WMAP Medicaid |
$24.43
|
| Rate for Payer: WPS Commercial |
$431.83
|
|
|
Cadmium, Occupational Exposure, Random, Urine
|
Professional
|
$89.00
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
6173611
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$104.02 |
| Rate for Payer: Aetna Commercial |
$84.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Aetna Managed Medicare |
$23.64
|
| Rate for Payer: Anthem Medicare Advantage |
$23.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.64
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$84.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.64
|
| Rate for Payer: Health EOS Commercial |
$80.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.64
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: Preferred Network Access Commercial |
$84.55
|
| Rate for Payer: Quartz Beloit One Network |
$39.16
|
| Rate for Payer: Quartz Commercial |
$50.73
|
| Rate for Payer: Quartz Medicare Advantage |
$23.64
|
| Rate for Payer: The Alliance Commercial |
$93.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.64
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$104.02
|
|
|
Cadmium, Occupational Exposure, Random, Urine
|
Facility
OP
|
$89.00
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
6173611
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$356.00 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Aetna Managed Medicare |
$23.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$88.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.37
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.24
|
| Rate for Payer: Anthem Medicaid |
$24.43
|
| Rate for Payer: Anthem Medicare Advantage |
$23.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.64
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.43
|
| Rate for Payer: Dean Health Medicaid |
$24.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23.64
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$87.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.64
|
| Rate for Payer: Managed Health Services Medicaid |
$25.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23.64
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$35.46
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$24.43
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$57.85
|
| Rate for Payer: Quartz Medicare Advantage |
$23.64
|
| Rate for Payer: The Alliance Commercial |
$356.00
|
| Rate for Payer: United Healthcare Medicaid |
$24.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.64
|
| Rate for Payer: United Healthcare PPO |
$66.75
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: Wellcare Medicare |
$23.64
|
| Rate for Payer: WMAP Medicaid |
$24.43
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
Cadmium, Occupational Exposure, Random, Urine
|
Facility
IP
|
$89.00
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
6173611
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.61 |
| Max. Negotiated Rate |
$81.88 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$53.40
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$53.40
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
Caffeine Level
|
Professional
|
$238.00
|
|
|
Service Code
|
CPT 80155
|
| Hospital Charge Code |
977893
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$226.10 |
| Rate for Payer: Aetna Commercial |
$226.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$204.68
|
| Rate for Payer: Aetna Managed Medicare |
$38.57
|
| Rate for Payer: Anthem Medicare Advantage |
$38.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.57
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cigna Commercial |
$226.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$119.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.57
|
| Rate for Payer: Health EOS Commercial |
$216.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$136.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.57
|
| Rate for Payer: Multiplan Commercial |
$190.40
|
| Rate for Payer: Preferred Network Access Commercial |
$226.10
|
| Rate for Payer: Quartz Beloit One Network |
$104.72
|
| Rate for Payer: Quartz Commercial |
$135.66
|
| Rate for Payer: Quartz Medicare Advantage |
$38.57
|
| Rate for Payer: The Alliance Commercial |
$152.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.57
|
| Rate for Payer: WEA Trust Commercial |
$130.90
|
| Rate for Payer: WPS Commercial |
$169.71
|
|
|
Caffeine Level
|
Facility
IP
|
$238.00
|
|
|
Service Code
|
CPT 80155
|
| Hospital Charge Code |
977893
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.62 |
| Max. Negotiated Rate |
$218.96 |
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$126.14
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cigna Commercial |
$218.96
|
| Rate for Payer: Health EOS Commercial |
$211.82
|
| Rate for Payer: HFN Commercial |
$218.96
|
| Rate for Payer: Multiplan Commercial |
$190.40
|
| Rate for Payer: NAPHCARE Commercial |
$142.80
|
| Rate for Payer: Preferred Network Access Commercial |
$218.96
|
| Rate for Payer: Quartz Beloit One Network |
$116.62
|
| Rate for Payer: Quartz Commercial |
$142.80
|
| Rate for Payer: WEA Trust Commercial |
$130.90
|
| Rate for Payer: WPS Commercial |
$176.29
|
|
|
Caffeine Level
|
Facility
OP
|
$238.00
|
|
|
Service Code
|
CPT 80155
|
| Hospital Charge Code |
977893
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.44 |
| Max. Negotiated Rate |
$952.00 |
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$204.68
|
| Rate for Payer: Aetna Managed Medicare |
$38.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$144.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$67.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$64.03
|
| Rate for Payer: Anthem Medicaid |
$15.44
|
| Rate for Payer: Anthem Medicare Advantage |
$38.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$126.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.57
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cigna Commercial |
$218.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$38.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.44
|
| Rate for Payer: Dean Health Medicaid |
$15.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$38.57
|
| Rate for Payer: Health EOS Commercial |
$211.82
|
| Rate for Payer: HFN Commercial |
$218.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$38.57
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.57
|
| Rate for Payer: Managed Health Services Medicaid |
$16.06
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$38.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$38.57
|
| Rate for Payer: Multiplan Commercial |
$190.40
|
| Rate for Payer: NAPHCARE Commercial |
$57.86
|
| Rate for Payer: Preferred Network Access Commercial |
$218.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.44
|
| Rate for Payer: Quartz Beloit One Network |
$116.62
|
| Rate for Payer: Quartz Commercial |
$154.70
|
| Rate for Payer: Quartz Medicare Advantage |
$38.57
|
| Rate for Payer: The Alliance Commercial |
$952.00
|
| Rate for Payer: United Healthcare Medicaid |
$15.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.57
|
| Rate for Payer: United Healthcare PPO |
$178.50
|
| Rate for Payer: WEA Trust Commercial |
$130.90
|
| Rate for Payer: Wellcare Medicare |
$38.57
|
| Rate for Payer: WMAP Medicaid |
$15.44
|
| Rate for Payer: WPS Commercial |
$176.29
|
|
|
Caffeine, Urine
|
Facility
IP
|
$109.00
|
|
|
Service Code
|
CPT 80155
|
| Hospital Charge Code |
3313617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.41 |
| Max. Negotiated Rate |
$100.28 |
| Rate for Payer: Aetna Commercial |
$98.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.77
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$100.28
|
| Rate for Payer: Health EOS Commercial |
$97.01
|
| Rate for Payer: HFN Commercial |
$100.28
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: NAPHCARE Commercial |
$65.40
|
| Rate for Payer: Preferred Network Access Commercial |
$100.28
|
| Rate for Payer: Quartz Beloit One Network |
$53.41
|
| Rate for Payer: Quartz Commercial |
$65.40
|
| Rate for Payer: WEA Trust Commercial |
$59.95
|
| Rate for Payer: WPS Commercial |
$80.74
|
|
|
Caffeine, Urine
|
Professional
|
$109.00
|
|
|
Service Code
|
CPT 80155
|
| Hospital Charge Code |
3313617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$169.71 |
| Rate for Payer: Aetna Commercial |
$103.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.74
|
| Rate for Payer: Aetna Managed Medicare |
$38.57
|
| Rate for Payer: Anthem Medicare Advantage |
$38.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.57
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$103.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.57
|
| Rate for Payer: Health EOS Commercial |
$99.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$136.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.57
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: Preferred Network Access Commercial |
$103.55
|
| Rate for Payer: Quartz Beloit One Network |
$47.96
|
| Rate for Payer: Quartz Commercial |
$62.13
|
| Rate for Payer: Quartz Medicare Advantage |
$38.57
|
| Rate for Payer: The Alliance Commercial |
$152.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.57
|
| Rate for Payer: WEA Trust Commercial |
$59.95
|
| Rate for Payer: WPS Commercial |
$169.71
|
|
|
Caffeine, Urine
|
Facility
OP
|
$109.00
|
|
|
Service Code
|
CPT 80155
|
| Hospital Charge Code |
3313617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.44 |
| Max. Negotiated Rate |
$436.00 |
| Rate for Payer: Aetna Commercial |
$98.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.74
|
| Rate for Payer: Aetna Managed Medicare |
$38.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$144.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$67.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$64.03
|
| Rate for Payer: Anthem Medicaid |
$15.44
|
| Rate for Payer: Anthem Medicare Advantage |
$38.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.57
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$100.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$38.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.44
|
| Rate for Payer: Dean Health Medicaid |
$15.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$38.57
|
| Rate for Payer: Health EOS Commercial |
$97.01
|
| Rate for Payer: HFN Commercial |
$100.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$38.57
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.57
|
| Rate for Payer: Managed Health Services Medicaid |
$16.06
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$38.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$38.57
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: NAPHCARE Commercial |
$57.86
|
| Rate for Payer: Preferred Network Access Commercial |
$100.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.44
|
| Rate for Payer: Quartz Beloit One Network |
$53.41
|
| Rate for Payer: Quartz Commercial |
$70.85
|
| Rate for Payer: Quartz Medicare Advantage |
$38.57
|
| Rate for Payer: The Alliance Commercial |
$436.00
|
| Rate for Payer: United Healthcare Medicaid |
$15.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.57
|
| Rate for Payer: United Healthcare PPO |
$81.75
|
| Rate for Payer: WEA Trust Commercial |
$59.95
|
| Rate for Payer: Wellcare Medicare |
$38.57
|
| Rate for Payer: WMAP Medicaid |
$15.44
|
| Rate for Payer: WPS Commercial |
$80.74
|
|
|
Calcitonin Level
|
Professional
|
$368.00
|
|
|
Service Code
|
CPT 82308
|
| Hospital Charge Code |
633686
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.79 |
| Max. Negotiated Rate |
$349.60 |
| Rate for Payer: Aetna Commercial |
$349.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$316.48
|
| Rate for Payer: Aetna Managed Medicare |
$26.79
|
| Rate for Payer: Anthem Medicare Advantage |
$26.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.79
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$349.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$184.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.79
|
| Rate for Payer: Health EOS Commercial |
$334.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$94.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.79
|
| Rate for Payer: Multiplan Commercial |
$294.40
|
| Rate for Payer: Preferred Network Access Commercial |
$349.60
|
| Rate for Payer: Quartz Beloit One Network |
$161.92
|
| Rate for Payer: Quartz Commercial |
$209.76
|
| Rate for Payer: Quartz Medicare Advantage |
$26.79
|
| Rate for Payer: The Alliance Commercial |
$105.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.79
|
| Rate for Payer: WEA Trust Commercial |
$202.40
|
| Rate for Payer: WPS Commercial |
$117.88
|
|
|
Calcitonin Level
|
Facility
IP
|
$368.00
|
|
|
Service Code
|
CPT 82308
|
| Hospital Charge Code |
633686
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$180.32 |
| Max. Negotiated Rate |
$338.56 |
| Rate for Payer: Aetna Commercial |
$331.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.04
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$338.56
|
| Rate for Payer: Health EOS Commercial |
$327.52
|
| Rate for Payer: HFN Commercial |
$338.56
|
| Rate for Payer: Multiplan Commercial |
$294.40
|
| Rate for Payer: NAPHCARE Commercial |
$220.80
|
| Rate for Payer: Preferred Network Access Commercial |
$338.56
|
| Rate for Payer: Quartz Beloit One Network |
$180.32
|
| Rate for Payer: Quartz Commercial |
$220.80
|
| Rate for Payer: WEA Trust Commercial |
$202.40
|
| Rate for Payer: WPS Commercial |
$272.58
|
|
|
Calcitonin Level
|
Facility
OP
|
$368.00
|
|
|
Service Code
|
CPT 82308
|
| Hospital Charge Code |
633686
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.79 |
| Max. Negotiated Rate |
$1,472.00 |
| Rate for Payer: Aetna Commercial |
$331.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$316.48
|
| Rate for Payer: Aetna Managed Medicare |
$26.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$100.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.47
|
| Rate for Payer: Anthem Medicaid |
$27.68
|
| Rate for Payer: Anthem Medicare Advantage |
$26.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.79
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$338.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.68
|
| Rate for Payer: Dean Health Medicaid |
$27.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26.79
|
| Rate for Payer: Health EOS Commercial |
$327.52
|
| Rate for Payer: HFN Commercial |
$338.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.79
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$27.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.79
|
| Rate for Payer: Managed Health Services Medicaid |
$28.79
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26.79
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26.79
|
| Rate for Payer: Multiplan Commercial |
$294.40
|
| Rate for Payer: NAPHCARE Commercial |
$40.18
|
| Rate for Payer: Preferred Network Access Commercial |
$338.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$27.68
|
| Rate for Payer: Quartz Beloit One Network |
$180.32
|
| Rate for Payer: Quartz Commercial |
$239.20
|
| Rate for Payer: Quartz Medicare Advantage |
$26.79
|
| Rate for Payer: The Alliance Commercial |
$1,472.00
|
| Rate for Payer: United Healthcare Medicaid |
$27.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.79
|
| Rate for Payer: United Healthcare PPO |
$276.00
|
| Rate for Payer: WEA Trust Commercial |
$202.40
|
| Rate for Payer: Wellcare Medicare |
$26.79
|
| Rate for Payer: WMAP Medicaid |
$27.68
|
| Rate for Payer: WPS Commercial |
$272.58
|
|
|
Calcitriol 1,25 Dihyroxy Level
|
Facility
IP
|
$606.00
|
|
|
Service Code
|
CPT 82652
|
| Hospital Charge Code |
978114
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$296.94 |
| Max. Negotiated Rate |
$557.52 |
| Rate for Payer: Aetna Commercial |
$545.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$321.18
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna Commercial |
$557.52
|
| Rate for Payer: Health EOS Commercial |
$539.34
|
| Rate for Payer: HFN Commercial |
$557.52
|
| Rate for Payer: Multiplan Commercial |
$484.80
|
| Rate for Payer: NAPHCARE Commercial |
$363.60
|
| Rate for Payer: Preferred Network Access Commercial |
$557.52
|
| Rate for Payer: Quartz Beloit One Network |
$296.94
|
| Rate for Payer: Quartz Commercial |
$363.60
|
| Rate for Payer: WEA Trust Commercial |
$333.30
|
| Rate for Payer: WPS Commercial |
$448.86
|
|
|
Calcitriol 1,25 Dihyroxy Level
|
Facility
OP
|
$606.00
|
|
|
Service Code
|
CPT 82652
|
| Hospital Charge Code |
978114
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$2,424.00 |
| Rate for Payer: Aetna Commercial |
$545.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$521.16
|
| Rate for Payer: Aetna Managed Medicare |
$38.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$144.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$67.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63.91
|
| Rate for Payer: Anthem Medicaid |
$39.78
|
| Rate for Payer: Anthem Medicare Advantage |
$38.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$321.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.50
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna Commercial |
$557.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$38.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.78
|
| Rate for Payer: Dean Health Medicaid |
$39.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$38.50
|
| Rate for Payer: Health EOS Commercial |
$539.34
|
| Rate for Payer: HFN Commercial |
$557.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$38.50
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$39.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.50
|
| Rate for Payer: Managed Health Services Medicaid |
$41.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$38.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$38.50
|
| Rate for Payer: Multiplan Commercial |
$484.80
|
| Rate for Payer: NAPHCARE Commercial |
$57.75
|
| Rate for Payer: Preferred Network Access Commercial |
$557.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$39.78
|
| Rate for Payer: Quartz Beloit One Network |
$296.94
|
| Rate for Payer: Quartz Commercial |
$393.90
|
| Rate for Payer: Quartz Medicare Advantage |
$38.50
|
| Rate for Payer: The Alliance Commercial |
$2,424.00
|
| Rate for Payer: United Healthcare Medicaid |
$39.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.50
|
| Rate for Payer: United Healthcare PPO |
$454.50
|
| Rate for Payer: WEA Trust Commercial |
$333.30
|
| Rate for Payer: Wellcare Medicare |
$38.50
|
| Rate for Payer: WMAP Medicaid |
$39.78
|
| Rate for Payer: WPS Commercial |
$448.86
|
|
|
Calcitriol 1,25 Dihyroxy Level
|
Professional
|
$606.00
|
|
|
Service Code
|
CPT 82652
|
| Hospital Charge Code |
978114
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$575.70 |
| Rate for Payer: Aetna Commercial |
$575.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$521.16
|
| Rate for Payer: Aetna Managed Medicare |
$38.50
|
| Rate for Payer: Anthem Medicare Advantage |
$38.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.50
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna Commercial |
$575.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$303.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.50
|
| Rate for Payer: Health EOS Commercial |
$551.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$135.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.50
|
| Rate for Payer: Multiplan Commercial |
$484.80
|
| Rate for Payer: Preferred Network Access Commercial |
$575.70
|
| Rate for Payer: Quartz Beloit One Network |
$266.64
|
| Rate for Payer: Quartz Commercial |
$345.42
|
| Rate for Payer: Quartz Medicare Advantage |
$38.50
|
| Rate for Payer: The Alliance Commercial |
$152.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.50
|
| Rate for Payer: WEA Trust Commercial |
$333.30
|
| Rate for Payer: WPS Commercial |
$169.40
|
|
|
Calcitriol Medication 0.25mcg
|
Facility
OP
|
$12.00
|
|
| Hospital Charge Code |
3005564
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial |
$10.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.32
|
| Rate for Payer: Aetna Managed Medicare |
$3.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.36
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.72
|
| Rate for Payer: Health EOS Commercial |
$10.68
|
| Rate for Payer: HFN Commercial |
$11.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11.04
|
| Rate for Payer: Quartz Beloit One Network |
$5.88
|
| Rate for Payer: Quartz Commercial |
$7.80
|
| Rate for Payer: Quartz Medicare Advantage |
$7.20
|
| Rate for Payer: The Alliance Commercial |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$6.60
|
| Rate for Payer: WPS Commercial |
$8.89
|
|
|
Calcitriol Medication 0.25mcg
|
Facility
IP
|
$12.00
|
|
| Hospital Charge Code |
3005564
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$11.04 |
| Rate for Payer: Aetna Commercial |
$10.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.36
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.04
|
| Rate for Payer: Health EOS Commercial |
$10.68
|
| Rate for Payer: HFN Commercial |
$11.04
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11.04
|
| Rate for Payer: Quartz Beloit One Network |
$5.88
|
| Rate for Payer: Quartz Commercial |
$7.20
|
| Rate for Payer: WEA Trust Commercial |
$6.60
|
| Rate for Payer: WPS Commercial |
$8.89
|
|
|
Calcitriol Medication 0.5 mcg
|
Facility
IP
|
$11.00
|
|
| Hospital Charge Code |
3005563
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$10.12 |
| Rate for Payer: Aetna Commercial |
$9.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.83
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna Commercial |
$10.12
|
| Rate for Payer: Health EOS Commercial |
$9.79
|
| Rate for Payer: HFN Commercial |
$10.12
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: NAPHCARE Commercial |
$6.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10.12
|
| Rate for Payer: Quartz Beloit One Network |
$5.39
|
| Rate for Payer: Quartz Commercial |
$6.60
|
| Rate for Payer: WEA Trust Commercial |
$6.05
|
| Rate for Payer: WPS Commercial |
$8.15
|
|
|
Calcitriol Medication 0.5 mcg
|
Facility
OP
|
$11.00
|
|
| Hospital Charge Code |
3005563
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$44.00 |
| Rate for Payer: Aetna Commercial |
$9.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9.46
|
| Rate for Payer: Aetna Managed Medicare |
$3.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.83
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna Commercial |
$10.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.16
|
| Rate for Payer: Health EOS Commercial |
$9.79
|
| Rate for Payer: HFN Commercial |
$10.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8.25
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: NAPHCARE Commercial |
$6.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10.12
|
| Rate for Payer: Quartz Beloit One Network |
$5.39
|
| Rate for Payer: Quartz Commercial |
$7.15
|
| Rate for Payer: Quartz Medicare Advantage |
$6.60
|
| Rate for Payer: The Alliance Commercial |
$44.00
|
| Rate for Payer: WEA Trust Commercial |
$6.05
|
| Rate for Payer: WPS Commercial |
$8.15
|
|
|
Calcium
|
Facility
IP
|
$128.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
2942966
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.72 |
| Max. Negotiated Rate |
$117.76 |
| Rate for Payer: Aetna Commercial |
$115.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.84
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$117.76
|
| Rate for Payer: Health EOS Commercial |
$113.92
|
| Rate for Payer: HFN Commercial |
$117.76
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: NAPHCARE Commercial |
$76.80
|
| Rate for Payer: Preferred Network Access Commercial |
$117.76
|
| Rate for Payer: Quartz Beloit One Network |
$62.72
|
| Rate for Payer: Quartz Commercial |
$76.80
|
| Rate for Payer: WEA Trust Commercial |
$70.40
|
| Rate for Payer: WPS Commercial |
$94.81
|
|
|
Calcium
|
Professional
|
$128.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
2942966
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$121.60 |
| Rate for Payer: Aetna Commercial |
$121.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.08
|
| Rate for Payer: Aetna Managed Medicare |
$5.16
|
| Rate for Payer: Anthem Medicare Advantage |
$5.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.16
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$121.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.16
|
| Rate for Payer: Health EOS Commercial |
$116.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.16
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Preferred Network Access Commercial |
$121.60
|
| Rate for Payer: Quartz Beloit One Network |
$56.32
|
| Rate for Payer: Quartz Commercial |
$72.96
|
| Rate for Payer: Quartz Medicare Advantage |
$5.16
|
| Rate for Payer: The Alliance Commercial |
$20.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.16
|
| Rate for Payer: WEA Trust Commercial |
$70.40
|
| Rate for Payer: WPS Commercial |
$22.70
|
|
